Sense of coherence and religion/spirituality: A systematic review and meta-analysis based on a methodical classification of instruments measuring religion/spirituality

The coherence hypothesis assumes that sense of coherence (SOC) explains the positive link between religion/spirituality (R/S) and mental health. The aim of our meta-analysis is to evaluate the evidence for the association between SOC (sensu Antonovsky) and different aspects of R/S and thus to contribute to the verification of the coherence hypothesis. Eighty-nine English- and German-language primarily cross-sectional studies with 67,913 participants met the inclusion criteria. The R/S scales of all included studies were subjected to item-by-item qualitative content analysis in order to determine whether scales do actually measure religion or spirituality and which R/S aspects dominated the instrument. Based on this classification, overall and subgroup meta-analyses were conducted using a random effects model. The adjusted effect size between SOC and all positive R/S measures was r+ = .120, 95% CI [.092, .149]. Particularly significant (r+ < -.180 or > .180) were correlations with negative R/S scales (r+ = -.405, 95% CI [-.476, -.333]), R/S instruments measuring primarily positive emotions (r+ = .212, 95% CI [.170, .253]) or meaning-making (r+ = .196, 95% CI [.126, .265]). Both sample characteristics (age, culture, gender, health status, religious affiliation) and study characteristics (e.g., publication year) had a moderating effect on the R/S-SOC connection. The correlation was particularly high in studies from Southern Asia (r+ = .226, 95% CI [.156, .297]), the African Islamic cultural value zone (r+ = .196, 95% CI [.106, .285]), and in a small subgroup of Iranian studies (r+ = .194, 95% CI [.117, .271]). The results confirm that R/S and SOC are clearly associated and suggest that there are different religious/spiritual pathways to a strong SOC. The strength of the associations presumably depends not only on individual differences, but also on cultural embeddedness and social plausibility of R/S. Trial registration. PROSPERO registration number: CRD42021240380. https://www.crd.york.ac.uk/prospero/display_record.php?ID = CRD42021240380.

"I do not divide life into sacred and secular; I believe all of life is infused with sacredness." Spiritual Orientation Inventory (Elkins et al. 1988

) Beliefs & Concepts
Self-image This code should be chosen when the item describes religious / spiritual ideas, practices or experiences that contribute to a positive self-image of the believer.
-If the item is formulated in such a way that the self-image appears exaggerated or unrealistic, the code grandiosity can also be assigned.
Appreciation, esteem, self-concept, selfconfidence "I try hard to grow in understanding of what it means to live as a child of God." Orientation to Growth and Striving (King & Hunt, 1975)

Beliefs & Concepts Truth
This code should be chosen if the item deals with the truth claims of religious / spiritual beliefs.
-If the item focuses on the search for the truth in the area of R/S, the code quest can also be selected.
Certainty, sure, true, truth, truthful, untrue "While we can never be quite sure that what we believe is absolutely true, it is worth acting on the probability that it may be." Religious Maturity Scale (Dudley & Cruise, 1990) Coping & Support

Coping
This code should be selected when the item describes an attempt to overcome a problem and / or achieve a positive state through the use of religious / spiritual resources. This code should also be chosen when the item describes a person's feeling, belief, or experience that the intervention of a transcendent power contributed to the success or resolution.
-Often this code occurs in the context of religious / spiritual coping strategies rated as successful. In this case, it overlaps with the code coping.
Collectivist Coping Styles Inventory (Heppner et al. 2006) Coping & Support Pastoral care This code should be chosen when the item refers to the positive and supportive role of pastoral care.
-Depending on the wording of the item, the codes social support, coping and / or church may also be considered. This code should be chosen if the item describes a religiously / spiritually based attitude characterized by a positive outlook on life and confidence.
-If the item refers in a narrower sense to trust in a transcendent power, the code trust should be assigned.
Assurance, confidence, hopeful, positivity, sanguine "While there is much evil in the world, I believe goodness, integrity and love also abound." Spiritual Orientation Inventory (Elkins et al.

Trust
This code should be chosen when the item describes trust in something or someone transcendent.
-If the trust does not refer to a transcendent source in the narrower sense, but rather describes a religious / spiritually determined positive attitude, the code optimism is appropriate.
Confidence, faith, reliance, trust "Whatever happens, I will trust in a higher power that carries me through." Reliance on God's help (Büssing et al. 2015) Emotion & Meaning Understanding This code should be selected if the item describes a person's feeling, belief or experience of understanding life, the environment or him / herself better through her / his religious or spiritual beliefs.
-If the item focuses on meaning-oriented understanding, the code meaning can also be assigned.
-If the item does not focus on emotional or meaning-oriented understanding, but on intellectual comprehension promoted by religious / spiritual knowledge, the code intellect should be assigned instead.

Autonomy & Quest
Grandiosity a. This code should be selected when the item deals with the (unrealistic or exaggerated) conviction of being superior to other people in the field of R/S. b. This code should also be selected if the item deals with the conviction of being able to exert an extraordinarily strong influence on the transcendental realm.
-If the conviction that one has an influence on transcendent realities does not seem excessive, the code control can also be chosen.
Unique, more than, special, better than, superior a. This code should be selected if the item explicitly addresses the personal or general importance of R/S. b. This code should also be selected when the item asks how much the person identifies with his / her church or religious / spiritual community.
Central, essential, identification, important, loyalty, profound, significant "My spirituality is a significant part of my life." Spiritual Perspective Scale (Reed, 1986) Centrality & Frequency Compliance a. This code should be selected when the item describes beliefs and behaviors that are consistent with the religious / spiritual convictions of the person and/or the observances of the religious / spiritual community. b. This code should also be selected if the item describes a person's desire or attitude to follow the will of something or someone transcendent. This code should be given if the item describes that and how a person has been shaped and socialized in her / his faith by other people or a religious / spiritual community.
-If the educational aspect is in the foreground, i.e., the acquisition of religious / spiritual knowledge, the code intellect can also be selected.
-If the item emphasizes the developmental aspect, the code development can also be assigned. -Some item formulations also suggest choosing the code family resource as well.

Social interaction
This code should be given when the item describes social interactions that are either religious / spiritually motivated, have R/S as topic, or take place in a religious / spiritual domain.
-If the focus is on the help that a person expects or receives through these social activities, the code social support can also be selected.
-If the core of the social interactions consists of religious / spiritual practices carried out together, then the code collective practice should be assigned instead.
Sharing, social activity, talking "The church is most important as a place to formulate good social relationships." Religious Orientation Scale (Allport & Ross, 1967) a Translated by first author. Wording of the original German item: "Mein Vater lässt mich meine eigenen Entscheidungen treffen über Religion und Glauben." b Translated by first author. Wording of the original German item: "Wie stark lebst du in deinem Alltag nach religiösen Geboten?" c Translated by first author.
Wording of the original Polish item: "Religia dostarcza odpowiedzi na pytanie, co jest dobre, a co złe." d Translated by first author. Wording of the original Austrian item: "In der freien Natur spüre ich die Gegenwart Gottes." e Translated by first author. Wording of the original German item: "Ich tue mein Bestes, um mit der Erkrankung fertig zu werden, und überlasse den Rest Gott / einer höheren Macht."